Children's Cancer hospital now testing vitamin D frequently and supplementing weekly

Improving Vitamin D testing and supplementation in children with newly-diagnosed cancer: A Quality Improvement Initiative at Rady Children’s Hospital San Diego

Ksenya Shliakhtsitsava,Erin Stucky Fisher,Erin Trovillion,Kelly Bush,Dennis Kuo,Ron Newfield,Courtney Thornburg,William Roberts,Paula Aristizabal

1. Unfortunately, they aim for only >30 ng     More vitamin D is needed for treatment than prevention * Cancer patients need more vitamin D, even those who are supplementing – observational study June 2021 * Vitamin D prevents and treats cancer in many ways – May 2021 * 8 ways that Cancer might be prevented by Vitamin D - June 2019 * Vitamin D Reduces Cancer Risk - Why Scientists Accept It but Physicians Do Not - Feb 2019 Dr. Grant Study ignored the importance of activation of the Vitamin D Receptor for Cancers * 4X less of one chemo needed after vitamin D receptor activation - June 2020 The risk of 44 diseases at least double with poor Vitamin D Receptor as of Oct 2019 * Omega-3,  Magnesium, Zinc,  Quercetin,  non-daily Vit D,  Curcumin, intense exercise,   Ginger,   Essential oils, etc**  Note: The founder of VitaminDWiki uses 10 of the 13 known VDR activators They wait months for the Vitamin D levels to respond Loading doses could achieve the same levels within a week     Note: Loading doses have been used on over 1 million childen during the past 70 years Would have been much better if they had increased Vitamin D levels before the surgery * Improve your health BEFORE surgery (prehabilitation) helps your recovery - 2018 * Children stayed in ICU 3.5 days longer if low vitamin D – Dec 2015 Even better - Have high vitamin D levels and not get Cancer in the first place * Cancer in children 6X more likely if very low vitamin D – Oct 2011 * Children with Cancer were 6X more likely to have less than 10ng of vitamin D – Feb 2011 * Chart of Vitamin D levels vs disease - Grassroots Health June 2013 --- Items in both categories Cancer and Infant-Child : {category} --- 1. # I will not be surprised if in the future they stop pushing Vitamin D They are given too little vitamin D, too late to make much of a difference

📄 Download the PDF from VitaminDWiki

Note:Most are weekly supplementations

Amazingly, they do not increase dose size with age: An 18 year-old needs much more than a 2 year-old

Increased testing

Increased supplementation

Background: Vitamin D deficiency and insufficiency have been associated with poorer health outcomes. Children with cancer are at high risk for Vitamin D deficiency and insufficiency. At our institution, we identified high variability in Vitamin D testing and supplementation in this population. Of those tested, 65% were Vitamin D deficient/insufficient. We conducted a quality improvement (QI) initiative with aim to improve Vitamin D testing and supplementation among children aged 2-18 years old with newly-diagnosed cancer to ≥ 80% over 6 months.

Methods: An inter-professional team reviewed baseline data, then developed and implemented interventions using Plan-Do-Study-Act (PDSA) cycles. Barriers were identified using QI tools, including lack of automated triggers for testing and inconsistent supplementation criteria and follow-up testing post-supplementation. Interventions included an institutional Vitamin D guideline, clinical decision-making tree for Vitamin D deficiency, insufficiency and sufficiency, electronic medical record triggers, and automated testing options.

Results: Pre-intervention: N=26 patients, four (15%) had baseline Vitamin D testing; two (8%) received appropriate supplementation. Post-intervention: N=33 patients; 32 (97%) had baseline Vitamin D testing; 33 (100%) received appropriate supplementation and completed follow-up testing timely (6-8 weeks post-supplementation). Change was sustained over 24 months.

Conclusions: We achieved and sustained our aim for Vitamin D testing and supplementation in children with newly-diagnosed cancer through inter-professional collaboration of hematology/oncology, endocrinology, hospital medicine, pharmacy, nursing, and information technology. Future PDSA cycles will address patient compliance with Vitamin D supplementation and impact on patients’ Vitamin D levels.